Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
What are the implications of a VP shunt located in the radiation field in a patient receiving treatment for breast cancer?
I don’t see any contradiction to RT here.
What is the appropriate dose to the dissected node-negative neck with indication for radiation due to advanced primary?
60 Gy/30 fractions if HPV negative. 50 Gy/25 fractions or equivalent if HPV-positive OPX.
What is your approach to nodal coverage in a patient with lateralized adenoid cystic carcinoma (ie., buccal mucosa) with positive lymph node(s)?
I would cover the ipsilateral neck and named nerve to at least the foramina at the skull base.
Will you wait to simulate, or resimulate, a patient after teeth extractions in preparation for HN cancer treatment?
The answer is, it depends. I do not have a specific policy, and it depends refers to which and how many teeth need to be extracted. The main questions to answer this question are: Will the extractions alter the set up? And as a corollary, will the extractions alter the use of an intraoral device? A...
How would you manage an elderly patient with a de novo TNBC in the setting of a remote prior ipsilateral breast cancer s/p mastectomy and implant?
Unusual case: Looks like a new primary based on the timeline and presuming repeat SNLN was done and is negative. If local treatment is adequate as above, one can skip RT. Otherwise, I would favor RT. Also, obtain BRCA testing.
Should the hemorrhage be included in the volume when treating brain mets with SRS?
Having seen hemorrhage around brain metastases which later resolves, revealing uninvolved parenchyma, I do not include extralesional hemorrhage in the target volume when treating brain metastases with SRS. In patients for whom the edges of metastases are obfuscated by blood, I tend to favor whole br...
Do you recommend adjuvant radiotherapy for an adult patient with localized myxopapillary ependymoma, WHO Grade 2, status-post gross total resection?
I assumed that this is a case of spinal ependymoma. Myxopapillary ependymomas are rare tumors and optimal therapeutic strategy involves a Gross Total Resection (GTR). The more complete the surgery the better the outcome. The role of postoperative radiation after a GTR is somewhat controversial but I...
Do you recommend neoadjuvant 177Lu-PNT2002 followed by MDT per the LUNAR trial as your preferred treatment approach for oligorecurrent prostate cancer, as opposed to MDT and PSMA-radioligand therapy used as temporally separate treatments?
I believe this randomized trial does provide high-level evidence that adding 177Lu-PNT2002 prior to SBRT improves PFS compared with SBRT alone. If it were available off trial, yes, I would personally recommend it as an option. Currently, that is not the case.We chose this sequencing because we thoug...
What SBRT dose would you give to a single external iliac lymph node recurrence (1 cm size) for a patient previously treated with salvage radiation to the pelvis?
35 Gy/5 is fairly safe in the re-irradiation setting, and in our experience, it's quite effective for nodal disease.
How do you manage the elective lymphatics in high risk squamous cell carcinoma of the skin?
For the high risk features mentioned in the question, elective RT to draining nodes and neural pathways should be considered. The acceptable dose/fx for elective RT in SCC is generally 50 Gy in 25 fx (ranges from 45-54 Gy). <1.8-2 Gy/fx is acceptable in dose painted plans. For the nodal fields a goo...